It is a common practice in medicine to use enteral feeding tubes to provide fluids and nutrition to moribund patients. These same enteral tubes may also be used to provide suction allowing emptying and decompression of the stomach and gastrointestinal (GI) tract. Enteral feeding tubes also provide a convenient means to give oral medications to those patients who otherwise could not swallow them; the pills are crushed and administered as a slurry in water through the tube.
Enteral tubes come in a variety of types, French sizes, and lengths depending on the insertion site and intended use. Types include G-tube and J-tubes (relatively short enteral tubes inserted thru surgically created openings in the abdominal wall leading into the gut and usually used for long-term nutrition for debilitated patients), naso-gastric tubes of various types (these may be single or multi-lumen, and can be used for gastric decompression or for administration of enteral nutrition, and generally tend to be long in length), and a variety of specialty enteral tubes placed for nutrition, medications, or other purposes. This latter group tend to be significantly longer tubes with narrow internal diameters and comprised of softer silastic materials; they are often used for extended term enteral feeding and become clogged more easily due to their long length and small bore diameter.
Not infrequently these enteral tubes become obstructed or clogged. This is often the result of the gemisch of nutrient protein solutions, fluid pH levels, administered medications, and pill fragments being incompatible with one another leading to a slug of material that clogs the tube. In these cases, the clog must be dislodged or broken-up so that patency can be restored and the enteral tube can continue to be used. Failure to unclog the enteral tube can necessitate its removal, a costly and time consuming procedure that often requires a trip to the emergency room and the presence of a skilled surgeon or specialist.
Because of the importance of maintaining the patency of enteral feeding tubes, many means have been developed to effect removal or break-up of obstructing clogs. The simplest method is to flush the enteral tube with copious amounts of water. A syringe is fitted to the enteral tube, and water is forcibly instilled until patency is restored or the tube is abandoned. This method is frequently unsuccessful in clearing the tube, and generating high pressures in the enteral tube may cause the tube to rupture, potentially leading to dangerous patient aspiration. This means of unclogging tubes has been modified by using acidic solutions such as fruit juice and cola to try and dissolve pill fragments and the like; studies report variable success with this method.
Another approach to unclogging plugged enteral tubes is to use a proteolytic enzyme solution in an attempt to dissolve proteinaceous clogs. Examples include pancreatic enzymes and the commercially available Clog Zapper™. This method has utility against protein-based clogs, but may be unsuccessful for clogs caused by other materials, and the long duration required for the enzymatic solution to work ties up valuable nursing staff for extended periods of time.
A further, very successful means of unclogging an enteral feeding tube is to use a probe or wire inserted into the bore of the tube to mechanically dislodge the clog. The Bionix Development Corporation DeClogger™ is one such example; a plastic member with a screw thread molded into its distal tip is inserted into the enteral tube and worked through the clog using a twisting motion. While effective, the limited length of the plastic member limits the DeClogger's utility to tubes of shorter length.
The TubeClear from CorPak Medsystems is another device that mechanically dislodges clogs. A TubeClear stent is introduced into the enteral tube and fed down the tube until it reaches the clog. The TubeClear is then attached to a base unit. A reciprocating motor in the base unit causes a wire member inside the stent to move forward and rearward at high speed; with each cycle the wire member extends past the stent sheath a short distance, impacting the clog. The rapid reciprocal action of the wire member against the clog causes it to break up and dislodge, restoring tube patency. While effective, the TubeClear is expensive to use and requires skilled nursing staff to administer and monitor the process.